For Ocular Prostheses

What is the prosthesis made of?
The ocular prosthesis is made from a plastic material called poly(methyl methacrylate), or PMMA. It is more commonly known as acrylic. PMMA is light weight and does not shatter.

How long does it take to make?
The ocular prosthesis is made over two separate appointments—1. The impression and fitting model (1 hour), and 2. paint (1 hour) and delivery (30 minutes). The prosthesis can be delivered approximately two hours after the painting is complete.

Since it is common for a new prosthesis to require minor adjustments. Please contact us if you feel your new prosthesis needs changes.

What is your warranty policy?
In cases where a prosthesis is paid in full, we will make any necessary changes and maintenance services free of charge until six months from the initial delivery date. This does not apply to situations where the prosthesis is not paid in full.

The warranty is void under the following conditions: if the prosthesis breaks outside of normal wear and tear conditions, if the prosthesis is lost, or if additional surgery changes the fit of the prosthesis.

How long must I wait to be fitted after having surgery?
The socket must be given at least six to eight weeks to heal before a custom prosthesis can be made. As a special service, we do offer a custom fabricated conformer for recently operated patients. This temporary solution can be made a few days following surgery.

Is the process going to hurt?
Some patients experience minor discomfort when an alginate impression is taken of the eye socket, but this process usually takes less than a minute. Patients should tell us if they have sensitive corneas, recent surgeries, or socket irritations. The fitting process should be pain free, but discomfort can be elevated if the patient is unable to relax.

Will it look natural?
We can modify the shape of the prosthesis to an extent to create eyelid symmetry and we will paint the prosthetic eye to match the color of your healthy eye. We are as much fine artists as we are medical professionals and do our best to achieve the optimal result. The prosthesis will look natural but movement varies between individuals.

How well will my eye move?
In an evisceration, the muscles are still attached to the sclera and the lost volume is replaced by an implant. The muscles are able to move the implant, and subsequently the prosthesis that sits snugly over the tissue-covered implant. The result is similar for enucleated sockets if the severed muscles are attached to the implant itself. An enucleated eye typically does not move as much an eviscerated eye due to the muscles sewn onto the implants being "shorter." An eye that fits poorly over the implant will not track well and is one reason for replacing an old prosthesis. Extensive trauma to the lid and socket may also adversely affect prosthetic motility. In some cases, the option of pegging, or coupling from implant to prosthesis, may be available.

How long will the prosthesis last?
An ocular prosthesis made from acrylic will last many years, although the American Society of Ocularists recommends a replacement every five years due to soft tissue displacement in the orbit affecting the fit of the prosthetic eye. A poor fit can have detrimental effects to the socket, eyelids, implant, as well as movement and the patient's overall cosmetic appearance. In children, eyes are replaced more frequently due to growth.

Signs of poor fit may include the prosthesis turning in the socket or falling out on a regular basis, persistent pain/discomfort even after professional cleaning, unusual tearing or excessive mucus that are becoming increasingly bothersome. Many changes happen slowly over time so it is important to see your ocularist for reevaluation on a regular basis.

What is the maintenance involved? Do I need to remove the prosthesis for cleaning?
We recommend that the prosthesis be removed cleaned with mild soap and water as needed. Some patients need to do so daily, while others are able to leave it in for months at a time. We will instruct you on how the removal and insertion process during your appointment. Regardless of how often you remove the prosthesis on a regular basis, it is important for your socket health and the longevity of the prosthesis to return to the ocularist’s office every six months to have it professionally cleaned, disinfected and polished.

Can it fall out?
Except in rare cases, properly fitted prosthetic eyes do not fall out. When you are wiping your eye, wipe from the temple towards your nose to minimize turning the eye. Sometimes a prosthesis can become dislodged if you push too hard along the lower eyelid. If you need to clean the eyelids, use a gentle dabbing motion along the lower lids rather than push it inwards.

Can I play sports? Will I be able to swim?
Any sport you feel comfortable playing is fine.  We recommend wearing eye protection while playing sports and goggles for swimming.

Should I wear eye protection?
We recommend wearing eye protection for the purpose of protecting your functioning eye.

For Facial Prostheses

What is the prosthesis made of?
Facial prostheses are made from medical grade silicone. The hardness of the silicone material used depends on the specific needs of each patient. A prosthesis made for implant-retention will contain an acrylic piece with metal components.

Patients who have their entire orbital contents removed will be fitted with a silicone orbital prosthesis that houses an acrylic eye piece.

How long does it take to make?
The facial prosthesis consists of the same steps as an ocular prosthesis, but over a longer period of time. Most facial prostheses can be completed in five appointments. The first appointment, impression, takes approximately one hour. The next step, fitting and sculpting, usually takes two 2-hour appointments to complete. However, the time it takes to complete this step can vary greatly on complexity of the prosthesis. Orbital patients will need to make an extra appointment to match the eye color. The last two appointments are intrinsic painting and extrinsic painting. Patients may choose to combine the painting steps into one full day. The appointments are usually scheduled one week apart to allow us time to prepare the prosthesis for the next step.

What is your warranty policy?
In cases where a prosthesis is paid in full, we will make any necessary changes free of charge until three months from the initial delivery date.

The warranty is void under the following conditions: if the prosthesis breaks or tears outside of normal wear and tear conditions, if the prosthesis is lost, if additional surgery changes the fit of the prosthesis, or if there is significant change to the contour of soft tissue requiring a new prosthesis to be made.

For orbital prostheses, the facial prosthesis warranty policy applies to the silicone component. The ocular component is covered under the warranty period of ocular prostheses.

Why is the warranty period shorter for the facial prostheses?
The silicone materials that make up a facial prosthesis is not as durable as the acrylic material that make up ocular prostheses. Also, changes to a facial prosthesis often require remaking or repacking the entire prosthesis rather than just fixing a small portion like we are able to do with the ocular prostheses. Facial tissues can change more dramatically than the ocular tissues, sometimes requiring a brand new prosthesis to be made just shortly after delivery. Due to the amount of time it takes us to make each prosthesis, we cannot extend the warranty period.

Most insurance companies recognize that facial prostheses need to be replaced more often and allow us to bill for a new prosthesis after three months.

Will it look natural?
A skilled anaplastologist can create a silicone prosthesis that looks very natural. We will design the prosthesis to hide the margin whenever possible, and match the color of your skin as best as we can. Due to the fact that the anaplastologist cannot see the results as he/she is painting, it may take more than one trial to achieve the best color match.

How long must I wait to be fitted after having surgery?
We typically allow six to eight weeks after surgery before taking an impression. The newer titanium implants have improved quality of osseointegration. We can begin the process when the skin is properly healed and implants are well integrated.

Is the process going to hurt?
Some patients experience minor discomfort when an impression is being taken due to the coldness or weight of the material. Patients should tell us if their skin is sensitive or are experiencing pain. The fitting process should be pain free.

How long will the prosthesis last?
A silicone prosthesis typically lasts 1-3 years depending on the prosthesis's thickness, hardness, and how well it is cared for. We choose the most durable material for a patient, but sometimes the prosthesis must be made very thin or be filled with a soft gel. In such cases the prosthesis will not last as long unless the wearer is very gentle with it. Tissue change can result in poor fit, making it necessary to change the prosthesis before the material expires. A poor fit can have negative effects on the overall cosmetic appearance, as well as the patient's ability to hear (auricular prosthesis) or breathe (nasal prosthesis). In children, prostheses are replaced more frequently due to growth.

What is the maintenance involved? Do I need to remove the prosthesis for cleaning?
We recommend that the prosthesis be removed daily and patients should not be sleeping with the prosthesis. Adhesives can be removed from the prosthesis as well as your skin with rubbing alcohol or a special adhesive removal wipe. The side of the prosthesis that contacts the skin should be cleaned with mild soap and water. Patients with implants should also clean around the implant site with mild soap and water using a small soft brush. We will instruct you on how to care for your prosthesis during the appointment.

Can it fall off?
Adhesive-retained prosthesis can fall off if the prosthesis is heavy. We offer adhesives of different strengths to minimize such situations. In areas of significant movement, the margin may lift away from the skin throughout the day. Some patients can feel when the prosthesis has shifted and will be able to press the prosthesis back in place. We also recommend carrying a small amount of adhesives with you at all times for touch ups.

Implant-retained prosthesis through bar and clip were formerly preferred for their retention strength, but newer magnets with improved strengths and an o-ring design is now comparable to the bar and clip option. An implant-retained prosthesis is generally stronger than adhesive-retained prosthesis and, rare occasions aside, do not fall off during the day.

Can I play sports? Will I be able to swim?
We recommend that you be comfortable with the retention of the prosthesis before playing sports with it. You may try it in a small setting first before risking the prosthesis falling off in public or in open water. Chlorine in a pool and exposure to sunlight will cause discoloration more rapidly.